AuSPEN NEWSLETTER
Number 4 : OCTOBER 1998

PRESIDENT'S REPORT

Greetings ! The AuSPEN Annual Scientific Conference on the 23rd and 24th October at the Canberra Convention Centre is in the final stages of preparation. This Conference will certainly be a special event for AuSPEN. The linking of the AuSPEN Conference with the Gastroenterology Society of Australia will offer opportunities for broader scientific programmes and meetings with new colleagues who are interested in nutrition. I hope that you will join us in Canberra !

I have just returned from Nice where I attended the European Society for Parenteral and Enteral Nutrition Congress. This was a terrific Congress and the experience was enhanced by the clear blue skies and sea and the atmosphere of the French Riviera. Alas I did not spend (all) my time on the beach ! A major achievement of this meeting was the formation of the International Confederation of Nutrition Support Organisations (ICNSO). This organisation links together the major parenteral and enteral nutrition societies through the developed and developing World with the aim to enhance nutrition support education. I am pleased to report that AuSPEN is a founding member of the organisation and is represented on the Executive Council of ICNSO.

The initial aims of this organisation are to provide four intranets accessible to the membership of the represented Societies. Over the next few months a Core Curriculum in Nutrition Support, initially for physicians and then other disciplines, will be developed. This will include resources from ASPEN, ESPEN and FELANPE and important journal references. This will provide a complete basic course in nutrition support via the Internet. An examination will be included at the completion of the course. Plans for Certification in Nutrition Support and Fellowships are being developed to follow on from this. I am very excited about this opportunity for us in AuSPEN and I will keep you informed regarding the progress of this project.

While in Nice I also attended the Board of Advisors Meeting for the Nutrition Science and Education Fund. Plans continue for an international meeting aimed to prioritise education and training in nutrition support in the developed and developing World.

AuSPEN's geographical position in the Asia-Pacific Region gives us an important opportunity to be there to assist our neighbours in the development of nutrition support. Through the Parenteral and Enteral Nutrition Society of Asia, (PENSA), we have been fortunate to develop strong links and friendships.

I look forward to meeting you all in Canberra.

Dr Julie Bines, President of AuSPEN


CONTACT ADDRESSES

Dr Julie Bines, President of AuSPEN, Dept. of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, MELBOURNE, Victoria 3000, Australia.
Ph +61-3-9345-5060. Fax +61-3-9345-6240
email bines@cryptic.rch.unimelb.edu.au

Mr Kevin Williams, Honorary Treasurer of AuSPEN , Pharmacy Dept., The Queen Elizabeth Hospital, Woodville Road, WOODVILLE, South Australia 5011, Australia.
Ph +61-8-8222-6692 Fax +61-8-8222-6019
kwilliams@tqehsmtp.tqeh.sa.gov.au






AGENDA FOR THE 1998 ANNUAL GENERAL MEETING
OF THE AUSTRALIAN SOCIETY FOR PARENTERAL AND ENTERAL NUTRITION

TO BE HELD ON FRIDAY 23rd OCTOBER 1998
THE NATIONAL CONVENTION CENTRE, CANBERRA, ACT.

  • 1 : Apologies
  • 2 : Minutes of the Annual General Meeting, October 1997.
  • 3 : Business arising from the Minutes
  • 4 : President's Report
  • 5 : Tresurer's Report
  • 6 : Presentation of the 1998 Travel Grant Awards
  • 7 : New Members of the Society
  • 8 : 1999 Annual Scientific Meeting - BRISBANE
  • 9 : Vote of Thanks to the Conference Organising Committee and the Sustaining Associates
  • 10 : GENERAL BUSINESS
    • Reports from the Committees - Strategic Planning, Scientific Program, Rsearch and Clinical Advisory, Professional Development.
    • Federation of Australian Nutrition Societies
    • International activities - Confederation of Parenteral and Enteral Societies, NSERF
    • Permanent Secretariat
    • Motion redarding Student Subscriptions
  • 11 : Other Business
  • 12 : Meeting Close
PROPOSED CHANGES TO THE AuSPEN CONSTITUTION
Page 3 Article 5 Dissolution : line 4 Insert student after active.
Page 4 Article 6 Membership :
  • Section 1 Classes, line 8 insert 5 classes of Membership, not 4
  • Insert 5. Student Membership Any individual who is in full time study where such study is in the scientific field of Parenteral and Enteral Nutrition.

Page 5 Section 2. Application for Membership
  • 2.(a) line 2 Insert student after active
  • 2.(a) (iii) line 2 Insert student after active
  • 2. (a) Insert (v) In the case of student membership, proof of student status is required
  • 2. (c) line 3 Insert student after active.

Page 6 Section Privileges, Duties and Voting : Line 1 Insert student after active
Page 7 Article 7 Dues Annual Subscription : Line 1 Insert student after active
Page 7 Article 8 Meetings Meetings:
  • Section 1 : Line 3 Insert student after active
  • Section 3 Quorum : Line 1 Insert student after active

Page 8 Article 9 Council and Office Bearers : No change proposed here.


MINUTES OF THE AuSPEN ANNUAL GENERAL MEETING

HELD ON FRIDAY 24th OCTOBER 1997
ESPLANADE HOTEL, FREMANTLE

MEMBERS PRESENT

Julie Bines (President) Kevin Williams (Hon Tresurer)
Paul Woods (Council) Margaret Allman-Farinelli (Hon Secretary)
Ibolya Nyulasi (Council) Sabita Rajeshwar (Council)

Nicolas Coroneos, Neil Cunningham, Melvyn Davis
Geoff Dobb, Kerry Forbes, Sharon Forbes
Tom Hartley, Narelle Hore, Robyn Huggins
Mirada Ip, Christine Kiddell, Penny MacLennan
Evania Marlow, Elizabeth Morrell, Jenny Mroz
David Russell, Liliana Sputore, Roger White

APOLOGIES

Leanna Read (Council) Darrell Crawford (Council) Bill Flukes

MINUTES OF THE PREVIOUS MEETING Ibolya Nyulasi moved that the minutes be accepted and was seconded by Tom Hartley

BUSINESS ARISING FROM THE PREVIOUS MINUTES There was no business arising from the previous minutes

PRESIDENT'S REPORT Julie Bines reported that the past year had been active one for AuSPEN. A Strategic Planning Meeting had been held to discuss the role and direction of the Society. A number of important issues were identified and subcommittees would be established to accomplish the necessary tasks including Scientific Program Committee, Clinical and Advisory Groulp, Professional Development and Education / Accreditation and Marketing. A report and a call for members for these committees would be published in the January Newsletter.

Clinical Practice Guidelines for Home Enteral Nutrition had been published and the Micronutrient Guidelines were ready for publication. The Practice Giidelines had indicated the important role AuSPEN may play in Government Policy Making and in Education Service to Members

The Newsletter continues and each issue seems better. Tom Hartley was thanked for his efforts in the publication of the Newsletter and also for establishing an AuSPEN homepage on the Internet.

Members should now be receiving the journal 'Nutrition'. A price for the next five years has successfully negotiated.

Julie Bines, as our President, represented AuSPEN at ICPEN which meets biannually at ASPEN and ESPEN Conferences. The Society will be represented by Ibolya Nyulassi at PENSA, (Parenteral and Enteral Nutrition Society of Asia)

Lastly a vote of thanks was moved to the Council members for their efforts.

The President's Report was moved to be accepted by Kevin Williams and was seconded by Melvyn Davis.

TREASURER'S REPORT The unaudited version was published in the October Newsletter and has now been audited. All the monies plus interest and fees which were outstanding after the 1993 Adelaide Conference have now been recovered. Thanks were extended to Kevin Williams for continuing to pursue this outstanding debt.

Roger Wood moved that the Treasurer's report be accepted and seconded by Ibolya Nyulasi.

TRAVEL GRANTS Three Travel Grants were awarded : to Kathryn Marshall, Indy Richardson and Deborah Jessen. It was moved that a condition of attendance at the AGM be incorporated into the Travel Grants.

NEW MEMBERS The following new Members have been admitted to the Society since the last AGM

Alison Missen (NZ) Michael Ward (QLD) Cameron Platell (WA) Leonie Pearce (VIC) Elisa Cleeve (VIC) Kathryn Marshall (VIC) Julie Morpeth (NZ) Helen Read (NSW) Nicola Riley (NSW) Cathy Vlouhos (NSW) Indi Richardson (VIC) Jenny McKercher (TAS) Irmeli Pentilla (SA) Corinna Steeb (SA)

1998 SCIENTIFIC MEETING will be in Canberra in association with the G.E. Society. A preliminary flyer was distributed in the satchels. The focus will be on gastrointestinal function and nutrition. A joint poster session is likely. Two speakers have been invited : Professor Alan Walker from Harvard has accepted and confirmation from the other speaker is pending. Members were invited to contact the following Members with ideas : Julie Bines, Narelle Hore, Sabita Rajeswar and Margaret Allman-Farinelli. Financial arrangements with the G.E. Society need to be finalised

Nursing delegates will be encouraged and it is possible the meeting may cooincide with the Hospital Pharmacists meeting. A workshop on research methodology has been suggested.

Julie Bines moved a vote of thanks to Paul Woods and his Committee for the excellent organisation of the Perth Scientific Meeting and the Social Programme. Roger White seconded this.

Julie Bines moved a vote of thanks to the Sustaining Associates seconded by Paul Woods. Sherwood Davis Geck has increased the value of the McMahon Prize for the Best Scientific Presentation as from 1998.

PROPOSED FEDERATION OF AUSTRALIAN NUTRITION SOCIETIES A meeting of various nutrition societies was convened by Professor Mark Wahlqvist to discuss formation of a federation. Among a number of proposals was that a joint conference be held in 2002. Some discussion about the Federation followed. It was suggested that AuSPEN continued to attend meetings of the proposed group.

PERMANENT SECRETARIAT AuSPEN is negotiating a permanent address with telephone and fax in association with the offices of ANZICS in Melbourne.

MOTIONS Two motions had been received.

The first proposed by Kevin Williams.

Re Membership Subscription : As I have highlighted to Council this year, the cost of running the Society has increased markedly over the last 2 to 3 years. If AuSPEN is to continue to provide a true quality service to Members it needs to focus on ways of increasing revenue through Membership Fees, Sponsorships and other sources that Council is currently identifying.

I propose that the Membership Subscription be increased to $100 pa from 1/1/98 to enable continuation of these services.

This was seconded by Paul Woods and passed unanimously.

David Russell proposed that for Full Time Student's a $70 fee, (verified by Supervisor) be instituted. Seconded by Ibolya Nyulasi. Motion passed unanimously.

The second motion was proposed by Margaret Allman-Farinelli and seconded by Paul Woods.

This motion is to change Section 2 of the Constitution 'Election to Council'. It is proposed the Members of Council be eligible to serve only four consecutive terms (previously only three) but he/she may be eligible for re-election after a further period of three years.

The Motion was passed unanimously.

An invitation for Members to volunteer for Council was made.

Margaret Allman-Farinelli passed a 'vote of thanks' to Julie Bines for her hard work as President which was passed by all.

The meeting closed at 6:30pm.


FINANCIAL REPORT FOR 1997



                             AuSPEN Balance Sheet
                       As of 31/12/97 (in Aus. Dollars)
  20/9/98                                                             
  AUSPEN-Bank,Cash,CC Accounts
                                                      31/12/97
                              Acct                     Balance

             ASSETS

               Cash and Bank Accounts
                 Current                                     0.00
                 Current New                            24,605.94
                 Term Deposit 1                              0.00
                 Term Deposit 2                              0.00
                 Term Deposit 3                         12,313.49
                 Term Deposit 4                          6,027.27

               Total Cash and Bank Accounts             42,946.70


             TOTAL ASSETS                               42,946.70

             LIABILITIES & EQUITY

               LIABILITIES                                   0.00
               EQUITY                                   42,946.70

             TOTAL LIABILITIES & EQUITY                 42,946.70


---------------------------------------------------------------------------


                        AuSPEN Profit & Loss Statement
                   1/1/96 Through 31/12/97 (in Aus. Dollars)
  20/9/98                                                             
  AUSPEN-Bank,Cash,CC Accounts
                                            1/1/97-           1/1/96-
           Category Description            31/12/97          31/12/96

    INCOME/EXPENSE
      INCOME
        Conference 93                         6,394.31            700.00
        Conference 95                             0.00          9,483.89
        Conference 96                           938.92              0.00
        Conference 97                        13,915.00              0.00
        Interest                              1,212.24          1,662.81
        Sponsorship                             825.00              0.00
        Subscriptions                        12,075.00         12,830.00
        Income - Other                          825.00              0.00

      TOTAL INCOME                           36,185.47         24,676.70

      EXPENSES
        Awards                                    0.00            300.00
        Conference '96                            0.00          5,117.39
        Conference '97                        2,000.00          3,500.00
        Council Meeting:
          Conferlink                        741.10            779.30
          QantasClub Fee                      0.00            450.00
          Room Hire                           0.00            691.30
          Travel                            499.40          6,008.00

        Total Council Meeting                 1,240.50          7,928.60
        Fees & Charges:
          Auditing fees                     400.00              0.00
          Bank Charges                      703.95            754.01
          Deposits Tax                        3.79              0.00
          Merchant Adjust                    75.00              0.00

        Total Fees & Charges                  1,182.74            754.01
        Freight                                   0.00             74.00
        Gifts                                     0.00             50.00
        Legal Expenses                          490.00            551.47
        Newsletter                            4,767.55          1,460.20
        Nutrition Jrnl.                      12,805.20              0.00
        Planning Day 97:
          Airfare                         4,191.20              0.00
          Consultant Fee                  1,660.00              0.00
          Facility Hire                   5,587.00              0.00
          Printing                           85.00              0.00

        Total Planning Day 97                11,523.20              0.00
        Posting                                 268.25            875.72
        Printing                                  0.00             84.40
        Stationery                                9.00            443.10
        Telephone                               444.90              0.00
        Travel:
          Travel Grant                        0.00          1,953.00
          Travel - Other                  2,185.19              0.00

        Total Travel                          2,185.19          1,953.00

      TOTAL EXPENSES                         36,916.53         23,091.89


    TOTAL INCOME/EXPENSE                       -731.06          1,584.81












LIPIDS, FATS AND BODY COMPOSITION

Dr Tom Hartley Pathology Dept. Royal Hobart Hospital

When thinking about this article for the October Newsletter my original plan was to attempt a comparative review of what was being published in the nutrition literature from the point of view of comparing the US journals with their predominantly american content with the European journals and their predominantly european authorship. Needless to say the task was overwhelming - I covered the last twelve months August '97 to July '98 of the journals : The American Journal of Clinical Nutrition, Clinical Nutrition and Nutrition Research. What did emerge largely because I started with the Am. J. Clin. Nutrit. was that there is a very significant proportion of the american literature devoted to fat and lipids and either directly or by inference to body composition. I tagged 115 articles in that journal to which you could assign one or more of these key words to. The other two journals provided a further 39. Because the total number of articles published in the Am.J.Clin.Nutr. so significantly exceeds the outputs of the other two journals there is no justification in making a numerical comparison. Suffice it to say there is a very significant body of literature on this topic and the challenge was then how to approach an assessment of it all.

A couple of years ago I presented a paper on Body Composition and Lipid Metabolism and I recall that at the time my original intention had been to give a fairly conventional lecture on the biochemistry of fatty acids, triglycerides, cholesterol etc. Then I came a across an article in New Scientist (1) which opened a whole new area to me - the comparative physiology of fat in mammals by a researcher with the Open University in the UK - Dr Caroline Ponds. The essential thrust of her work and other researchers in this field is that not all fat depots can be regarded as being metabolically identical. In mammals fat is located in several important depots- thoracic, pericardial, epicardial, subcutaneous, omental, mesenteric, epididymal, perirenal, calf, trapezius, breats, clavicular, buttock and thigh. Ponds has studied fat depots not only in humans but in over 57 wild and captive animals belonging to 17 species and 8 orders (2). They have differed in total body mass by six orders of magnitude - guinea pigs to deer. Her findings suggest that fat is not just a high energy fuel reserve and insulator - it is in fact a well differentiated metabolic system of depots resourcing requirements of the adjacent tissues especially muscle (3) and in fat adjacent to lymph nodes.

By studying substrate cycling of

  • glucose to and from glucose-6-phosphate
  • fructose-6-phosphate to and from fructose-1,6-diphosphate
  • lipid to and from glycerol plus free fatty acids

in adipose tissue isolated from different depots, it would appear for example that :

  • intermuscular depots have elevated and sex dependent fatty acid / triglyceride recycling rates
  • the epicardial depot has an elevated capacity for fatty acid release
  • mesenteric and omental depots are more sensitive to insulin mediated inhibition of lypolysis
  • calf, perirenal, trapezius and mesenteric depots have site specific fatty acid compositions of their triacylglycerols

So now I have returned to the latest clincal literature from the point of view of identifying papers where some of these important body fat compartmentalisation findings appear to have been taken into consideration.

The only paper I found where there had been direct sampling of subcutaneous fat for study was by Garland et al. (4) They took adipose tissue aspirates from 140 nurses, collected from the buttocks with a 19 gauge needle attached to a 20 ml syringe. Chemical analyses of these biopsies showed that when you compared the chemical composition with the food intake histories then the chemical measurements correlated best with the diet history estimates of vegetable sourced intakes of total polyunsaturated fat, linoleic acid, linolenic acid and trans- fatty acids. Correlation with animal sourced trans- fatty acids was not so good.

Sex related aspects of lipid metabolism and body composition have been reported in the past twelve months but the preponderance has been on studies in women only. Lehtimaki et al (5) have found that in men there is a relationship between serum low density lipoprotein concentrations and fasting and that different apo E phenotypes showed inter group differences in this decline. Women subjects, however, showed no such phenotypic differences. Similarly men showed phenotypic related changes in their serum lipids but women did not.

Ethnic studies were also quite commonly reported. Perhaps the most complete was that by Ellis (6) who studied 297 males in three ethnic groups - 145 white european americans, 78 black african americans and 74 mexican americans (hispanics). They used the dual X-ray absoptiometry method which is usually regarded as a candidate 'gold standard' in body composition measurements and thereby were able to quantitate bone mineral content, lean tissue mass and body fat simultaneously. Bone mineral content and lean tissue mass were indistinguishable when whites were compared with hispanics. Blacks had higher values for these two parameters than the whites and hispanics. There was a simple linear relationship between bone mineral content and lean tissue mass and this was found to be totally independent of age or ethnic group. Age was probably not a factor because they were all young males - aged 3 to 18 - so no 'ageing process' would have been present. As a group the hispanic males had significantly higher body fat than the whites or blacks. They were able to derive two satitically significant equations (r=0.971) for predicting bone mineral content or lean tissue mass which were independent of ethnic group :

  • Lean Tissue Mass, kg = 0.019 * Bone Mineral Content, g + 5.89
  • Bone Mineral Content, g = 51.25 * Lean Tissue Mas, kg - 258.8

The paper by Taylor et al (7)is of particular interest because it used the dual X-ray absorptiometry method to measure body fat mass and then went on to correlate these with anthropometric methods applied to the same subjects. Unfortunately the study was restricted to 96 women white women aged 16 - 80 years. Their sensitivity (True Positives /(True Positives + False Negatives)) and specificity (True Negatives / (False Positives + True Negatives)) table was as follows; I calculated the values for the waist to hip ratio from their data and were not stated specifically by the authors.

Anthropometric Measure SENSITIVITY SPECIFICITY
BMI equal to or greater than 27.3 as a measure of total adiposity
83%
94%
Waist to Hip Ratio equal to or greater than 0.81 as a measure of visceral adiposity
42%
71%
Waist circumference equal to or greater than 86.9 cm as a measure of central adiposity
83%
94%

They were confident to recommend the BMI cut off of 27.3 and waist circumference cut off of 86.9 cm as being reasonably reliable estimates of regional adposity in these women.

Perhaps a more fully documented correlation study along the same lines - MRI imaging of body composition versus anthropometry - was reported by Conway et al (8), however, this was restricted to a smaller group of 48 african american women and no false positive false negative data are reported. In a previous study they had reported that african american women have smaller visceral adipose tissue deposits than white women and the object of this next study was to determine if they could correlate the sizes of these deposits with anthropometry.

  • MEASUREMENTS
    • Waist circumference
    • Waist circumference to hip circumference ratio
    • Subscapular skinfold thickness
    • Ratio of triceps to subscapular skinfold
    • Visceral adipose tissue measured at the level of the L4 - L5 lumbar vertebrae using MRI
    • Percentage of fat was determined by dual energy X-ray absorptiometry

  • SUBJECTS
    • 48 women
    • All >120% ideal body weight
    • Weight to height ratios > 0.85 were classified as having upper body obesity, N = 23
    • Weight to height ratios < 0.76 were classified as having lower body obesity, N = 25

  • RESULTS
    • Women with upper body obesity had visceral adipose tissue = 0.26 +/- 0.02
    • Women with lower body obesity had visceral adipose tissue = 0.19 +/- 0.02
    • Waist circumference was the best predictor of visceral adipose tissue
    • Waist to height ratio correlated with visceral adipose tissue only in women with upper body obesity

The last two papers that I felt qualified for inclusion is this discussion involve fat metabolism. Melanson et al (9)has investigated the phenomenon that older women appear to accumulate more fat than younger women from the point of view of fat oxidation rates. 16 women were involved in their study which involved fasting and consuming meals of 1046, 2092 or 4184 kJ each containing 35% fat. They found that the younger women could increase their fat oxidation rates linearly in response to the increasing fat intake but that the older women could not once they reached the 2093 kJ intake. The fat oxidation and deposition rates at the 4184 kj meal intake were :

Fat Oxidation Fat Deposition
Young Women
1029 kJ
464 kJ
Older Women
781 kJ
745 kJ

Their experiments suggested that when older women consume large meals they oxidised significantly less of the fat content and deposit significantly more of the fat than younger women.

Finally I have included in this section on body composition and body fat compartments the report by Gower et al (10) because it relates body composition studies with insulin status. They used the 'gold standard' methods of body composition measurement - dual energy X-ray absorptiometry to determine total body fat and computerized tomography to determine abdominal and intraabdominal fat depots. They made the measurements on 73 black and white american children with the plan of identifying ethnic differences in insulin responses.

African americans White americans Significance
Fasting serum insulin, pmol/L
79 +/- 37
55 +/- 23
p < 0.01
Insulin 30 mins into glucose tolerance test, pmol/L
567 +/- 438
300 +/- 304
p < 0.01
Fasting insulin vs Total Fat
r2 = 0.42
r2 = 0.52
30 mins Insulin vs Total Fat and Intraabdominal Fat Not correlated
r2 = 0.71
Area Under the Curve vs Subcutaneous Abdominal Fat
r2 = 0.49
Not correlated

They concluded that although the white children showed generally stronger correlations between indices of body fatness and insulin than did the african americans, the correlations were sufficiently strong for both groups to have obesity assigned as a disease risk factor.

There were four other papers which I felt were also worthy of inclusion in this review although they probably do not fit exactly the criteria I set out at the begining. There were three on leptins and one on cholesterol.

Grinspoon et al (11)have investigated the changes in serum leptin concentrations during 4 days of fasting in 14 healthy, normal females with a BMI of 24.2 +/- 3.6 and in whom they were also able to make bioelectric impedance based measurements of body fat.

Ages 24 +/- 4 years
Fall in plasma Leptin - 54% +/-8 % p = 0.0006
Leptin vs insulin r2 = 0.48 p = 0.0057
Leptin vs Body Fat r2 = 0.19 p= 0.03

At the end of 4 days of fasting 7 of the subjects continued to fast but were given a steady infusion of glucose equivalent to 114 +/- 323 kJ/day. As a result their serum leptin concentrations increased significantly. Overall they concluded that serum leptin concentrations were particularly sensitive to energy supply.

While on the topic of leptin variability, ethnic related variability in serum leptin concentrations has been reported by Luke et al (12) in 1434 black men and women from Nigeria, Jamaica and the USA with a very wide range of Body Mass Indices : 14 to 62.

Nigeria Jamaica USA
Number 363 372 699
Serum Leptin : Men 2.8 ug/L 3.9 ug/L 6.8 ug/L
Serum Leptin : Women 10.3 ug/L 18.6 ug/L 27.7 ug/L

The data in the table show clearly how the leptin concentrations in women were all greater than in the men. The researchers also found that when they plotted Leptin concentration on the y-axis and body fat on the x-axis then they could fit two identical exponential curves to the data - the only difference being that the curve for the women was parallel and displaced upwards from the curve for men by a constant amount. They interpreted the exponential shape of the curves as being evidence of a progressive leptin resistance developing as body fat stores increased.

The sex differences in serum leptin concentrations have been documented by Bennett et al (13). In their cohort of 375 subjects they found

Serum Leptin ng/L
Women 18.5 +/- 13.9
Men 3.8 +/- 3.6

They also collected some body composition data using bioelectrical impedance analysis and anthropometry and using these they were able to do a statistical analysis that compensated for differences in for either percentage body fat or total fat mass. Having done this the differences still persisted and there was a further indication from the analysis that the fat depot responsible for the difference may well be that estimated in the hips circumference measurement.

The last paper that I selected on cholesterol metabolism was a review by Jones (14). One of the features of TPN is the dramatic fall in serum cholesterol. I and others have attributed this to the withdrawal of oral sources of cholesterol and the interuption of the enterohepatic recirculation of biliary cholesterol. This review reports that fasting for 24 hours results in an almost complete cessation of cholesterol biosynthesis. In contrast increasing meal frequency progressively decreases endogenous cholesterol synthesis. A fascinating phenomenon is that consuming polyunsaturated fat stimulates endogenous cholesterol biosynthesis and it sounds as though this stimulatory effect is greater for these polyunsaturated fats than for other fats. Clearly cholesterol biodynamics are an area of complex phenomena worthy of some further reading.

REFERENCES

(1) Vines G. Adipose is OK New Scientist. 146:34-7, (1995)

(2) Pond CM. Mattacks CA. BIOCHEMICAL CORRELATES OF THE STRUCTURAL ALLOMETRY AND SITE SPECIFIC PROPERTIES OF MAMMALIAN ADIPOSE TISSUE Comp Biochem Physiol. 92:455-63,(1989)

(3) Calder PC. Harvey DJ. Pond CM. Newsholme EA. SITE SPECIFIC DIFFERENCES IN THE FATTY ACID COMPOSITION OF HUMAN ADIPOSE TISSUE Lipids. 27:716-20, (1992).

(4) Garland M. Sacks FM. Colditz GA. Rimm EB. Sampson LA. Willett WC. Hunter DJ. THE RELATION BETWEEN DIETARY INTAKE AND ADIPOSE TISSUE COMPOSITION OF SELECTED FATTY ACIDS IN US WOMEN American Journal of Clinical Nutrition. 67(1):25-30, 1998 Jan.

(5) Lehtimaki T. Frankberglakkala H. Solakivi T. Koivisto AM. Laippala P. Ehnholm C. Jokela H. Koivula T. Nikkari T. THE EFFECT OF SHORT-TERM FASTING, APOLIPOPROTEIN E GENE POLYMORPHISM, AND SEX ON PLASMA LIPIDS American Journal of Clinical Nutrition. 66(3):599-605, 1997 Sep.

(6) Ellis KJ. BODY COMPOSITION OF A YOUNG, MULTIETHNIC, MALE POPULATION American Journal of Clinical Nutrition. 66(6):1323-1331, 1997 Dec.

(7) Taylor RW. Keil D. Gold EJ. Williams SM. Goulding A. BODY MASS INDEX, WAIST GIRTH, AND WAIST-TO-HIP RATIO AS INDEXES OF TOTAL AND REGIONAL ADIPOSITY IN WOMEN - EVALUATION USING RECEIVER OPERATING CHARACTERISTIC CURVES American Journal of Clinical Nutrition. 67(1):44-49, 1998 Jan.

(8) Conway JM. Chanetsa FF. Wang P. INTRAABDOMINAL ADIPOSE TISSUE AND ANTHROPOMETRIC SURROGATES IN AFRICAN AMERICAN WOMEN WITH UPPER- AND LOWER-BODY OBESITY American Journal of Clinical Nutrition. 66(6):1345-1351, 1997 Dec.

(9) Melanson KJ. Saltzman E. Russell RR. Roberts SB. FAT OXIDATION IN RESPONSE TO FOUR GRADED ENERGY CHALLENGES IN YOUNGER AND OLDER WOMEN American Journal of Clinical Nutrition. 66(4):860-866, 1997 Oct.

(10)Gower BA. Nagy TR. Trowbridge CA. Dezenberg C. Goran MI. FAT DISTRIBUTION AND INSULIN RESPONSE IN PREPUBERTAL AFRICAN AMERICAN AND WHITE CHILDREN American Journal of Clinical Nutrition. 67(5):821-827, 1998 May.

(11)Grinspoon SK. Askari H. Landt ML. Nathan DM. Schoenfeld DA. Hayden DL. Laposata M. Hubbard J. Klibanski A. EFFECTS OF FASTING AND GLUCOSE INFUSION ON BASAL AND OVERNIGHT LEPTIN CONCENTRATIONS IN NORMAL-WEIGHT WOMEN American Journal of Clinical Nutrition. 66(6):1352-1356, 1997 Dec.

(12) Luke AH. Rotimi CN. Cooper RS. Long AE. Forrester TE. Wilks R. Bennett FI. Ogunbiyi O. Compton JA. Bowsher RR. LEPTIN AND BODY COMPOSITION OF NIGERIANS, JAMAICANS, AND US BLACKS American Journal of Clinical Nutrition. 67(3):391-396, 1998 Mar.

(13) Bennett FI. Mcfarlaneanderson N. Wilks R. Luke A. Cooper RS. Forrester TE. LEPTIN CONCENTRATION IN WOMEN IS INFLUENCED BY REGIONAL DISTRIBUTION OF ADIPOSE TISSUE American Journal of Clinical Nutrition. 66(6):1340-1344, 1997 Dec.

(14)Jones PJH. REGULATION OF CHOLESTEROL BIOSYNTHESIS BY DIET IN HUMANS [Review] American Journal of Clinical Nutrition. 66(2):438-446, 1997 Aug.


CALENDAR OF NATIONAL AND INTERNATIONAL MEETINGS

October 8th - 11th : The 23rd Australian & New Zealand Annual Scientific Meeting on Intensive Care, Adelaide Convention Centre. Prof Jonathan Cohen - Infection / Sepsis Dr Deborah Cook - Evidence Based Practice Prof Sergio Fanconi - Paediatric Intensive Care Prof Huda Huijer Abu-Saad - Nursing Research / Pain Assessment Prof Michael Matthay - Acute Lung Injury Ms Sandra Mattheson - Credentialling Prof Sander Van Deventer - Inflammation / Cytokines Ms Kathleen Vollman - Prone Positioning in Acute Lung Injury

Contact : Festival City Conventions, PO Box 949, KENT TOWN, South Australia 5071
Ph: 08-8363-1307 Fax: 08-8363-1604
email: fcceaton@ozemail.com.au

October 16th - 17th : European Academy of Nutritional Sciences '98: Nutrition and Adolescence , Madrid. Contact Gregorio Varela-Moreiras, Scientific Secretariat, Facultad de CC Exp y Técnias, Universidad San Pablo-CEU, Ctra Boadilla, km 5,3, 28668 Boadilla del Monte, Madrid, Spain. +34-1-3520144. Fax +34-1-3510475.
email: gvarela@ceu.es

October 19th - 22nd 1998 : The American Dietetic Association Annual Meeting and Exhibition, Kansas City Convention Center, Kansas City, MO. Contact The American Dietetic Association, 216 West Jackson Boulevard, Chicago, IL 60606-6995. Tel 312- 899-0040. Fax 312-899-0008.
email: mtgsinfo@eatright.org. Internet: http://www.eatright.org.

23rd and 24th OCTOBER 1998 : 24th ANNUAL SCIENTIFIC MEETING OF AuSPEN
National Convention Centre : Canberra

To be held in conjunction with Australian Gastroenterology Week.
Topics of Interest The main programme includes the following topics :

  • Nutrition support, early enteral feeding and outcomes in the intensive care setting
  • Criteria for assessing nutritional efficacy
  • Mucosal barrier function, intestinal permeability and adaptation in relation to nutrition and disease states
  • Growth factors and nutritional therapy in liver disease
  • Clinical and nutritional management of short bowel syndrome
  • Nutrition support in paediatric inflammatory bowel disease
  • Decision pathways in nutrition support
  • Evaluation of disease specific formulae
  • Aboriginal health issues

International Guest Speakers We are priviledged to have the following World renowned experts as Key Speakers

  • Dr Kenneth Kudsk MD , Professor of Surgery, Director of Surgical Research at the University of Tennessee. Currently the President of ASPEN and a most distinguished researcher in the areas of parenteral and enteral nutrition in surgery, trauma and sepsis.

    In Canberra he will be speaking on

    • Reducing infectious complications with nutrition support in the critically ill
    • morbidity and mortality critera for assessing nutritional efficacy
    • evaluating disease specific formulae

  • Dr Alan Walker MD, Professor of Nutrition and Paediatrics, Director Harvard Clinical Nutrition Research Centre, is an international expert on the human gastrointestinal host defense system and the role of nutrition. His Canberra lecture topics include

    • The development of mucosal barrier function in gastrointestinal disease
    • The role of nutrients in the treatment of paediatric inflammatory bowel disease
    • Decision pathways in nutrition support

  • In addition, Professor Reiken, Head of the Department of Gastroenterology at the Benjamin Franklin University, Berlin, will be presenting on the adaptive response of the mucosal barrier function and

  • Dr Michael Barnett from the Welsh School of Pharamacy will be speaking on pharmacological controversies.

National Speakers We are fortunate to be represented by a number of excellent national speakers covering a wide range of topics to cater for a variety of interests. They include

  • Dr David Bihari , Intensivist from Sydney, who will be talking about early enteral feeding and nutritional outcomes in the Intensive Care Unit and disease specific formulae.
  • Dr Geoff Davidson , Gastroenterologist from Adelaide, will be speaking about intestinal permeability and gut function.
  • John Hall , Professor of Surgery from Perth, will present on the clinical and nutritional management of short bowel syndrome.
  • Professor David Brewster from Darwin will talk on infection and Aboriginal health.

Workshops As well as the main programme, two concurrent workshops will be running on the morning of Saturday 24th October. These are :

  • Home Enteral Feeding in Australia. Speakers from all over Australia including Ms Ibolya Nyulasi, Director of Nutrition Services from Melbourne will be involved in the workshops. Pertinent and controversial issues involving home enteral nutrition will be examined.

    • Controversies in Nutrition Support Speakers such as Dr Julie Bines, Dr Ralph Heines, Dr Felicity Walker all from Melbourne and Ms Joy Blacks, CNC from Sydney, will tackle topics such as approaching nutrition research, estimating energy requirements and nutritional assessment, monitoring patients with respect to biochemistry and micronutrients, as well as enteral and parenteral therapy issues.

    • The AuSPEN Home Enteral Nutrition Guidelines and the Micronutrient Guidelines , two valuable resources, will be launched during the course of these workshops.

Venue Being located in Australia's Parliamentary city, the National Convention Centre is a major conference facility. It is outstandingly equipped and ideally located. A range of accomodation has been earmarked for the conference including the Park Royal Hotel in close proximity to the Convention Centre. Social functions being organised include a welcome cocktail party and a conference dinner, which will be held at the majestic High Court building. We hope you will be able to attend these and join us in making them an unforgetable experience.

  • Convenor : Ms Sabita Rajeshwar, Dietitian, New Children's Hospital, Westmead NSW. Ph 02-9845-2225 Fax 02-9845-3489 email sabitar@nch.edu.au
  • Committee Members :
    • Dr Margaret Allman Farinelli , Lecturer, University of Sydney, NSW. Ph 02-4351-3758
    • Ms Marcelle Middleton, Dietitian
    • Ms Karen Kingham, Dietitian St George Hospital, NSW Ph 02-9350-2752
    • Ms Karen Storer, Dietitian St Vincent's Hospital, NSW Ph 02-9361-2555
    • Ms Vanessa Glaros, Dietitian St George Hospital, NSW Ph 02-9350-3944
    • Prof. David Bihari, St George Hospital NSW Ph 02-9350-1111
    • Conference Secretariat : Ms Elaine Siggins and Ms Rosalie McCormack , PO Box 894, North Sydney, NSW 2069. Ph 02-9256-5454 Fax 02-9241-4586 email gesa@racp.edu.au

October 26th - 30th : International Course on the Use of Body Composition Techniques in Laboratory and Field Studies , Wageningen, Netherlands. Sponsored by the Graduate School VLAG. Contact P Deurenberg, Wageningen Agricultural University/Landbouwuniversiteit Wageningen, Division of Human Nutrition and Epidemiology, PO Box 8129, 6700 EV Wageningen, Netherlands. Ph +31-317-485108. Fax +31-317-483342.
email: paul.deurenberg@staff.nutepi.wau.nl Webpage : www.wau.nl.vlag/eduvlco.ht

November 2nd - 4th : Advances in Pediatric Nutrition , Renaissance Harborplace Hotel, Baltimore. Sponsored by the Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine. Contact Program Coordinator, Office of Continuing Medical Education, Johns Hopkins University School of Medicine, Turner Building 20, 720 Rutland Avenue, Baltimore, MD 21205-2195.
Ph +1-410-955-2959. Fax +1-410-955-0807.
email: cmenet@som.adm.jhu.edu

November 29th - December 2nd : Nutrition Adelaide 98: Challenges for the 21st Century , Adelaide Hilton International Hotel, Adelaide, Australia. Sponsored by the Nutrition Society of Australia and the Australasian Clinical Nutrition Society. Contact Conference Secretariat, Festival City Conventions Party Limited, PO Box 949, Kent Town, Australia 5071. Ph. 08 8363 1307. Fax 08 8363 1604.

December 11th - 13th : Clinical Controversies - Issues in Therapeutics , presented by the Society of Hospital Pharmacists of Australia, at the Wrest Point Convention Centre, Hobart, Tasmania.
Conference Secretariat : Clinical Controversies Conference, Mures Convention Management, Victoria Dock, Hobart, Tasmania, Ph 03-6234-1424 Fax 03-6234-4464 email: conventions@mures.com.au

January 26th - 29th 1999 : 23rd ASPEN Conference will be held in San Diego. Contact : ASPEN, 8630 Fenton Street, Suite 412, Silver Spring, MD 20910, USA. Ph. +1-301-587-6315 or fax +1-301-587-2365
email : aspen@access.digex.net

March 21st - 26th, 1999 : 4th Winter Research Conferences on Free Radicals , Valloire, France. Contact Arlette Alcaraz, CHU Grenoble, Laboratoire de Biochimie C, BP 217, 38043 Grenoble Cedex 09 France. Ph +33-4-7676-5754 Fax +33-4-7676-5664.
email: Arlette.Alcaraz@ujf-grenoble.fr or Alain.Favier@ujf-grenoble.fr

May 2nd - 7th, 1999 : Tenth International Symposium on Trace Elements in Man and Animals , Evian, France. Contact Arlette Alcaraz, CHU A Michallon, Laboratoire de Biochimie C, 38043 Grenoble Cedex 9, France. Ph +33-4-7676-5754. Fax +33-4-7676-5664.
email: cerlib@ujf-grenoble.fr

June 17th - 19th, 1999 : Eighth European Nutrition Conference , Lillehammer, Norway. Sponsored by the Norwegian Nutrition Society, Federation of European Nutrition Societies, and the European Academy of Nutritional Sciences. Contact Lillehammer Arrangement AS, PO Box 14, N-2601 Lillehammer, Norway. Ph +47-61-251705. Fax +47-61-256515.
email: lillarra@sn.no Webpage :www.nutrition.uio.no/nse/8thFENS_EANS

October 7th - 9th, 1999 : International Symposium on in vivo Body Composition Studies, Brookhaven National Laboratory, Upton, NY. Contact S Yasumura, Bldg 490, Medical Department, PO Box 5000, Brookhaven National Laboratory, Upton, NY 11973-5000. Ph +1-516-344-3606. Fax +1-516-344-5311.
email: yasumura@bnl.gov.

October 18th - 21st, 1999 : The American Dietetic Association Annual Meeting and Exhibition, Georgia World Congress Center, Atlanta. Contact The American Dietetic Association, 216 West Jackson Boulevard, Chicago, IL 60606-6995. Ph +1-800-877-1600, ext 4866. Fax +1-312-899-0008.
email: mtgsinfo@eatright.org Webpage : www.eatright.org







INTERNET NEWS

One of the best nutrition resources on the Internet http://arborcom.com/clin_2_p.htm is now best viewed in the frames version at http://arborcom.com/frame/arborframe2.htm

The non-frames version looks as though it may not be fully synchronised with the frames version if the entries in the Conference section of the former is anything to go by - the latest conference in the former is dated July '97. Personally I find frames versions a bit inefficient - you always end up with the navigation frame taking up 25% - 35% of your display. Turning off the Status bar and the Tool bars in Internet Explorer gives you more viewing area which can help especially when there seems to be no scroll bar on one of the frames and you can just see the tops of the next item on the menu. Still for those of you lucky enough to have newer and higher resolution screens (800 X 600) than mine will not notice ! Anyway the Conference section has now been hotlinked to Doctors Guide which you can access in full screen mode directly at

http://www.pslgroup.com/MEDCONF.HTM

This has a search engine but be careful - searching on the word 'nutrition' is answered with a list on conferences that are not in date order - in fact some of the conference lists appeared to be sorted by date and others not - there was no consistentcy when I delved in a little further ! Report of the Ministerial Working Party on Home Enteral Nutrition can be seen on

http://hna.ffh.vic.gov.au/ahs/hen/index.html

ASPEN is located at

http://www.clinnutr.org/

this is the title page and from there you can navigate to all other sections. I went and viewed and then printed out a the August issue of ASPEN NEWS which is usually only distributed to members and/or subscribers to JPEN. It is an Adobe Acrobat document at

http://www.clinnutr.org/augnews.pdf


DISCLAIMER

The views and opinions expressed in this Newsletter are not necessarily the views and opinions of the Australian Society of Parenteral and Enteral Nutrition. Reports and articles on techniques, procedures and products are provided for the information of the Members of the Society and their inclusion does not imply any endorsements from the Australian Society of Parenteral and Enteral Nutrition. No liability can or will be accepted by AuSPEN or its agents for the third party use of information in this Newsletter.

Dr Tom Hartley, Editor, 29/09/98.


Newsletter of the Australian Society for Parenteral and Enteral Nutrition
Editor : Dr Tom Hartley, 36, Pregnells Road, Sandfly, Tasmania 7150, Australia

Ph 03-6239-6475 (AH) 03-6222-8780 (BH) Fax 03-6231-3145
email hartley@southcom.com.au

AuSPEN WWW Homepage : www.southcom.com.au/~hartley/home.htm